The hematoma of soft fabrics is the cavity formed as a result of a trauma and filled with blood or clots. Arises at a blood izlitiya in fabric from the damaged vessel. Represents the dense or fluctuating opukholevidny education, painful at a palpation, followed by hypostasis and change of skin color. At a deep arrangement it is shown by violation of a form and local increase in volume of an affected area. Pathology is diagnosed on the basis of complaints, data of the anamnesis and external survey. In doubtful cases the ultrasonografiya is appointed. Treatment – local conservative actions, in hard cases is shown opening, drainage.
Hematoma of soft fabrics
Hematoma of soft fabrics – a widespread pathological state in traumatology. Can come to light in extremities, the person or a trunk, to be small or extensive, to settle down hypodermically, intramuscularly, podfastsialno, under a mucous membrane. Small superficial hematomas are found in fingers of hands, extensive congestions of blood more often – in a zone of the lower extremities (a shin and a hip). Small educations quite often resolve independently. At hit of an infection suppuration is observed. Pathology is diagnosed for all groups of the population, some prevalence of people with the high level of physical activity (children, young men) is noted.
Hematomas can be found at any kinds of traumatic damages (road, production, falling from height and so forth), but the home accident is the most common cause of their education. Pathology usually arises after direct stroke at a bruise, can be formed owing to an intensive sdavleniye, a rupture of a vessel at fractures, dislocations and other damages. The contributing factors increasing probability of development of this state are the diseases which are followed by violations from the curtailing system of blood and the increased fragility of a vascular wall.
The rupture of a blood vessel without existence of a wound is the cornerstone of the mechanism of formation of a hematoma of soft fabrics, is more rare – at a small wound (usually chipped). Intensive local traumatic influence at a bruise, damage by a bone otlomk, sharp unnatural shift of one anatomical structures is relative others at a fracture or dislocation becomes a cause of infringement of integrity of a vascular wall. Blood under pressure follows and "moves apart" fabrics, forming a cavity. A part of blood impregnates fabrics therefore the cyclic changes of color of integuments caused by disintegration of erythrocytes with formation of a gematoidin and gematosiderin are observed further. In the beginning the place of damage becomes crimson or crimson and cyanotic, gets a greenish, and then yellowish shade later. At deep hematomas skin color can remain not changed.
In the subsequent the hematoma either resolves, or is long remains, undergoing a number of the consecutive changes which are coming to the end with scarring. When opening fresh educations blood scarlet, viscous, dense, sometimes jellylike that is explained by activity of factors of folding. Later in a cavity either old clots, or dark liquid lizirovanny blood are found. At depletion of chronic hematomas clots can be firm, form integral weight, it is bad to separate from surrounding fabrics that is connected with the begun process of scarring and regeneration in fibrous fabric. The infected cavities are filled with serous or purulent contents.
Systematization is carried out on several signs. The purpose of division into groups is assessment of weight of pathology, the choice of medical tactics, definition of need of carrying out surgical intervention and the most probable forecast. In clinical practice distinguish the following types of hematomas:
- On localization. Hematomas can be located under skin, in a submucous layer, under a fastion, in the thickness of muscular tissue. The largest cavities are localized in muscles or podfastsialno (between a muscle and a fastion) that is caused by rich blood supply and elasticity of skeletal muscles.
- On a condition of a vessel. The pulsing hematomas are formed at damage of a vessel of big caliber, differ in absence of blood clot in a damage zone, a possibility of the free movement of blood from an education cavity in a cavity of a vessel and back. Not pulsing hematomas are found at violation of integrity of small and average vessels which defect of a wall is quickly closed by blood clot.
- On a condition of the streamed blood. Not curtailed (fresh) hematomas come to light during the first hours or the days after a trauma which were curtailed – several days later, lizirovanny (filled with the old blood incapable of folding) – in several weeks. The specified terms can fluctuate depending on activity of factors of folding, the amount of education and other circumstances. At penetration of an infection infection, later – suppuration is observed.
- In relation to fabrics. At development of diffusion hematomas process of treatment of fabrics by blood prevails over process of their "drawing apart", the cavity small or is absent. When forming limited formations of fabric are impregnated slightly, the bulk of the streamed blood is in a cavity. Osumkovanny hematomas are defined in the remote terms, are characterized by existence of a layer of the dense connecting fabric separating a cavity from surrounding structures.
- On severity. Slight hematomas arise approximately in a day after a traumatic excess, resolve independently more often. Formations of average weight are formed within 3-5 hours, demand holding conservative or operational actions. Heavy damages are diagnosed in 1-2 hours after a trauma, are the indication for opening and drainage.
Pain and local hypostasis become the first displays of pathology. Characteristic difference of a hematoma from other injuries of soft fabrics at an early stage is more expressed limitation of a swelling, lack of gradual transition from edematous structures to not changed. In the next hours hypostasis begins to extend. Morbidity amplifies, the movements are limited because of pain. Patients show complaints to feeling of pressure or tension in the struck zone. At a superficial arrangement of a hematoma skin becomes cyanotic-crimson. At deep localization of a cavity local hyperaemia of integuments can come to light, sometimes skin color does not change.
At a palpation at the initial stage fluctuation usually is absent, consolidation and sharp morbidity is defined. After formation of the limited cavity containing liquid blood the positive symptom of a zybleniye comes to light. In the beginning the struck area at palpation intense, after falling off of hypostasis density of fabrics can decrease. At a favorable current the swelling gradually decreases in a size and disappears, at adverse – remains for a long time, causes morbidity at the movements.
The main possible negative consequence of a hematoma of soft fabrics is its suppuration with formation of abscess. The complication is found at the accompanying damages of integuments more often. At hit of infectious agents in an education cavity the pain syndrome amplifies, local hyperaemia and a hyperthermia is noted, symptoms of the general intoxication join. Distribution of purulent process with formation of phlegmon or development of sepsis is in some cases possible.
Diagnostics is performed by the traumatologist. In the absence of signs of damage of bones and joints additional researches usually are not required, the diagnosis is exposed taking into account data of the anamnesis (existence is fresher than a trauma with the characteristic mechanism), complaints of the patient and results of fizikalny inspection. At deeply located hematomas for assessment of weight of damage and a differentiation with a bruise ultrasonography of soft fabrics can be appointed. At the accompanying defeat of firm structures the X-ray analysis of the corresponding segment is carried out. Except a bruise differential diagnostics sometimes should be carried out with changes, anguishes of sheaves and muscles, is more rare – with a syndrome of a position sdavleniye, a sharp miozit, ischemia at thrombosis of a vessel of small or average caliber and some other states which are followed by dense local hypostasis.
Treatment of a hematoma of soft fabrics
Treatment is usually performed on an outpatient basis, tactics is defined by weight of process and time from the moment of a trauma. At fresh injuries of an extremity give sublime situation, put cold (a hot-water bottle with cold water, the packages of ice wrapped in a towel), apply the pressing bandage for reduction of bleeding. After the organization of small educations appoint UVCh, apply warm hot-water bottles to acceleration of a rassasyvaniye. The small superficially located hematomas open in the conditions of emergency station. At large and deep cavities, emergence of signs of infection hospitalization in traumatologic office, opening and drainage against the background of antibiotic treatment is shown. At not infected hematomas after opening hard bandaging for elimination of a cavity and acceleration of healing is recommended.
Forecast and prevention
The forecast is usually favorable. The majority of hematomas resolves independently within 2-3 weeks. The average term of disability after opening of a cavity makes about 2 weeks, the absolute recovery becomes an outcome. In the absence of medical actions formation of the massif of fibrous fabric (hem) with formation of an outer defect is possible. In the presence of an infection terms of treatment and the forecast can fluctuate, depend on weight of process. Prevention includes prevention of injuries and the early request for medical care when receiving damages.